Special contribution by Ann Kough, PT, DPT, MBA, CLT
Our PT gets personal about an effective technique for urge incontinence that helps patients effectively hold their pee
“Is it normal to leak urine?”
“Is it normal to have pain with intercourse?”
“Is it normal to pull up to my garage door and not be able to make it to the bathroom?”
Honestly, this is the stuff everyone wants to know when they come here. Physical therapy offers a safe place to discuss pelvic floor issues. People just don’t talk about leaky bladders in their daily lives. It’s too personal.
Urge incontinence, also called overactive bladder, is when a person leaks urine with a strong “gotta go” feeling in the bladder. It is a big part of life for many women. (And men, too, but they really don’t talk about it!)
This problem affects people of all ages. There are young women who know every toilet in the mall and patients who cannot finish nine holes on the golf course without making a potty stop. When I talk about urge incontinence, I can see the lightbulb go on in people’s minds. If someone reads this blog and thinks, Oh – that’s me! they’re not alone!
It’s mind over matter with an overactive bladder
Pelvic floor physical therapy helps women manage urge incontinence through strengthening and learning to control the brain/bladder urge signal.
Many patients come to me figuring, Oh, I just need to do some Kegel exercises because I’m weak. In reality though, the strength of someone’s pelvic muscles may not be the only factor.
Urge incontinence is all about the bladder talking to the brain, and the brain talking to the bladder. The most effective treatment technique I have found is to retrain the bladder, which in essence means retraining the brain. It’s mind over matter, and it can be surprisingly fun.
Here’s how urge incontinence works. The bladder sends a very strong, urgent signal to the brain. The brain interprets that message to mean the bladder can’t hold urine any longer, so it triggers contractions in the bladder and urine can leak through the muscles of the pelvic floor. However, the bladder may not be full.
“Urgency is a bladder/mind connection that can be retrained.”
Pelvic floor physical therapy teaches the art of distraction for urge incontinence
In pelvic floor physical therapy, I teach patients how to mentally distract the brain from interpreting the incorrect message. When a woman has the feeling that she really has to go to the bathroom, but then she actively distracts herself by thinking about something else entirely, it stops the urge. It’s hard at first, but this technique works for so many people.
For example, I’ll start an exercise with a patient, such as having her sit then quickly tighten and release the pelvic floor muscles a few times. This causes the bladder to relax and is not meant to hold back urine. Then I ask her to count backwards from 100 by fours. If she gets the numbers wrong, even better! The brain will be working to do the math and relax its grip on the bladder.
Patients realize that overcoming urgency isn’t so difficult after all. In fact, patients help me come up with motivating mantras like, “My bladder is not the boss of me!” and “I’m the boss of my bladder.”
Bladder training is an easy way to conquer incontinence
The hardest part of physical therapy for urinary incontinence isn’t the exercises. It’s getting patients to come in for help in the first place. I want to assure women that with pelvic floor physical therapy, education is a key component to achieving their goals. We address other issues such as diet and bladder habits.
Learning to retrain the bladder is honestly the easiest thing to do for this problem. It’s one of my favorite things to help people with because it works for many women.